The role of sense of coherence in workplace violence directed at nurses in the shadow of COVID-19: A cross-sectional study

Workplace violence as a crisis: Using O'Rourke's theory as a framework to foster role clarity and professional role commitment

BACKGROUND

Workplace violence (WPV) against nurses, particularly by patients and visitors, poses a significant challenge to the profession and patient care. Nurses are introduced to the ethical principle of Do No Harm early in their education, yet this obligation becomes complex when their own safety is at risk.

PURPOSE

This paper examines nurses' experiences with WPV and its impact on professional role commitment and quality care. It offers a theory-driven, evidence-based framework to guide nurse executives and educators in addressing WPV.

METHODS

Drawing from sociology, psychology, and WPV research, this paper employs O'Rourke's middle-range theory to identify interventions that address the environment of care, healthcare workers, and nurses.

DISCUSSION

WPV not only threatens nurses' physical safety but also disrupts the alignment between professional role expectations and obligations, straining their professional role identity and commitment. Effective strategies and supportive interventions, particularly from nurse leaders, are critical.

CONCLUSION

Addressing WPV through theory-driven, evidence-based strategies is essential to ensuring nurse safety, strengthening professional role identity, and sustaining a committed nursing workforce.

Emergency Department Crowding as Contributing Factor Related to Patient-Initiated Violence Against Nurses-A Literature Review

AIM

To synthesise how ED crowding contributes to patient-initiated violence against emergency nurses.

DESIGN

Framework synthesis.

DATA SOURCES

A systematic literature search was conducted in the PubMed, PsycINFO, CINAHL and Scopus databases, covering articles up to 21 March 2024.

REVIEW METHODS

A total of 25 articles were reviewed, evaluating study quality using the Crowe Critical Appraisal Tool and employing a framework synthesis approach to chart and synthesise data.

RESULTS

The review identifies key factors linking emergency department crowding to patient-initiated violence, focusing on crowding conditions, vulnerable populations and adverse outcomes. It emphasises the importance of multidimensional assessments, including input, throughput, output stages and staffing characteristics. Special attention is needed for patients with severe symptoms who are triaged into lower priority categories, as their perceptions of injustice and dissatisfaction may increase the risk of aggressive behaviour. However, limited information is available regarding the perspectives of patients' family members.

CONCLUSION

Accurate assessments of emergency department crowding and a thorough understanding of cognitive and emotional changes in high-risk patients are essential to develop strategies to manage patient-initiated violence effectively.

IMPACT

This review improves emergency nurses' understanding of the dynamics of patient-initiated violence in crowded emergency departments, equipping them with knowledge to better anticipate and respond to such incidents. It also offers insights that are crucial for enhancing nursing practices and ensuring workplace safety, thereby supporting the development of future emergency safety strategies.

NO PATIENT OR PUBLIC CONTRIBUTION

As this is a systematic review and framework synthesis, there was no direct patient or public involvement.

Factors affecting intent to perpetrate violence against nurses: Theory of Planned Behavior approach

BACKGROUND

The Theory of Planned Behavior (TPB) has been found to predict target behaviors. The literature examining this model lacks attention to violence toward nurses.

PURPOSE

To explore the association between the public's exposure to violence and intention to employ violence toward nurses, under the TPB framework.

METHODS

A cross-sectional study (705 participants) employed a self-report questionnaire. Path analysis assessed TPB variables' mediation between prior exposure to violence and violent intent toward nurses.

DISCUSSION

The TPB variables, that is attitudes, subjective norms, and perceived control, mediated only the association between exposure to physical violence and intention to act violently. Subjective norms were the strongest mediator. The explained variance was 31%.

CONCLUSION

When addressing violence against nurses, policymakers must consider attitudes, subjective norms, and perceived control among patients and their attendants. Violence directed at nurses and health care workers reflects societal violence and the "upstream approaches" needed to mitigate violence in health care settings.